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Bush: Smallpox Vaccine
Is Your Call
White House plan suggests
voluntary inoculations for most of nation
< December
12, 2002 > The Bush administration is leaving it
up to you to decide if you want to receive the controversial smallpox
vaccine.
But by making immunization
voluntary, the White House has left Americans in the difficult position
of having to weigh the theoretical risks of a smallpox attack with
the small but concrete odds of suffering a serious or deadly side
effect from the vaccine.
Under the Bush plan, expected
tomorrow, as many as a half million soldiers will be required to
receive the vaccine. They will be followed by up to about 10 million
health and emergency personnel, the so-called "first responders"
charged with immunizing others and containing infections in the
event of an attack with the frequently deadly virus.
The rest of the nation
will have the option of getting vaccinated, possibly beginning in
2004. The smallpox vaccine is effective against the virus, but it
can lead to deadly complications in about one in every one million
people who receive it. Another 10 to 15 per million suffer serious
side effects, such as severe rashes.
"I think it ought to be
a voluntary plan. I don't think people ought to be compelled to
make the decision which they think is best for their family," Bush
told ABC News in an interview that aired in part yesterday.
Two-thirds of Americans
say they would receive the smallpox vaccine despite the risk of
serious side effects, according to a new poll by the Robert Wood
Johnson Foundation.
The Bush plan differs
from early thinking about the best vaccination strategy for smallpox.
First reports suggested that the total number of people who would
be offered the inoculation—which involves scratching weakened
vaccinia virus beneath the skin with a tiny fork-like device—would
be 15,000.
The United States abandoned
routine immunization against the virus in 1972, and the World
Health Organization declared the infection eradicated in
1980. However, the United States and Russia have preserved samples
of the virus, and intelligence experts fear that Iraq and North
Korea have supplies of it, too.
Health officials are now
stockpiling enough doses of smallpox vaccine to immunize the entire
country if needed. Roughly 60 percent of the population alive today
was born before routine smallpox vaccination ended, but scientists
do not know how much protection they may have retained. A study
of 900 people is now under way to determine just that.
So should you get the
vaccine when it is available? And what if you already were immunized?
"I would not personally
consider that I am protected even though I had a shot as a child,"
said Edward Kaplan, a Yale University smallpox vaccine expert. On
the other hand, he added, people who have already been immunized
are probably less likely to suffer side effects the second time
around.
Pregnant women, people
with HIV and AIDS, and those with certain skin conditions should
not be given the smallpox vaccine in a pre-attack inoculation program.
Whether they choose to do so during an outbreak depends on the scope
and severity of the attack, Kaplan said.
Kaplan said he believes
a voluntary system for the general public is the right approach.
But making the decision to get inoculated will require careful thinking
and cost-benefit analysis. "It sort of depends on what the post-attack
planning is in your state," Kaplan said. "In some places I have
more confidence than in others."
The Centers for
Disease Control and Prevention (CDC) announced today that
it has reviewed smallpox vaccination plans from 49 states and four
cities. The plans, which vary by jurisdiction, outline where the
shots would be administered. According to the CDC,
the vaccine will be available at 3,300 healthcare facilities and
hundreds of clinics nationwide.
Kaplan said some states
are considering a strategy of "ring vaccination," in which a small
group of first responders is tasked with trying to contain an outbreak
by inoculating as few people as necessary. That approach, he said,
makes him nervous.
"If I was in a state where
that was the agreed-upon policy, I would think very hard about getting
vaccinated on a voluntary basis," said Kaplan, who strongly prefers
a much broader tack where an entire city would be offered the protection.
Ironically, the more people who opt for vaccination, the more prudent
waiting becomes, since those who do get the vaccine serve as a buffer
for the rest.
But not every expert agrees
with the Bush decision. Dr. John Neff, a pediatrician at the University
of Washington who has studied smallpox, said the public does not
need to be vaccinated before an outbreak.
"Right now, unless we
know more about what the President is thinking, I think that the
potential risk from an adverse event is higher than from getting
and dying from smallpox," Neff said. "The first line of defense
makes a certain amount of sense. To have everybody get it on their
own choice makes no sense," said Neff, who argues that the Bush
decision was driven more by the looming war in Iraq than consideration
about what is scientifically appropriate.
Unnecessarily encouraging
mass inoculations might have devastating repercussions in the rest
of the world, said Neff. The United States can control an outbreak
within its borders, but it almost certainly cannot keep the infection
within them, he said. Although Europe might have enough vaccine
to quash a limited smallpox outbreak if it crops up there, South
American nations almost certainly do not.
"If we use [vaccine stocks]
up by having unnecessary vaccinations we would not be looked upon
favorably by the rest of the world and we couldn't help them," Neff
said.
Always consult your physician
for more information.
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Resources
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Centers
for Disease Control and Prevention (CDC)
National
Center for Allergy and Infectious Diseases, Part of the National
Institutes of Health (NIH)
World
Health Organization (WHO)
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more information on infectious disease, please visit the Infectious
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Bush Approves Optional Smallpox Shots
for All Americans
< December
12, 2002 > President Bush has approved a plan to
offer the risky smallpox vaccine to all Americans, but not to make
it mandatory, ABC News says.
The shots will be required
only for front-line health workers and military personnel beginning
sometime next year. All Americans will have the option to be vaccinated
by some time in 2004, when enough of the vaccine will be available
to inoculate the entire population.
Older stockpiles of the
vaccine will not be used unless there is a bioterror attack
before enough new vaccine is produced.
The White House plans
a major public education campaign before the vaccine is made widely
available. Studies from the 1960s predicted that about 15 of every one
million people would suffer a serious reaction to the vaccine, and
one or two of them would die.
Bush revealed details
of the plan during an interview with ABC News' Barbara Walters.
It will be broadcast in its entirety on Friday's 20/20. Bush will
discuss details with the American people tomorrow before the broadcast,
administration officials said.
Two of Three Americans
Favor Smallpox Vaccine, Poll Says
< December
12, 2002 > Two out of three Americans say they
would get the smallpox vaccine despite the risk of serious side
effects, according to a new poll.
A telephone survey of
1,002 adults, conducted for the Robert Wood Johnson Foundation,
indicates that people are more concerned about smallpox being used
in a bioterror attack than they are about possible vaccine repercussions,
the Orlando, Fla., TV station WESH 2 reports.
Most respondents also
said that when it came to information about how to protect themselves,
they had more faith in their physicians than the government. And
they believe America is only slightly better prepared to deal with
a bioterrorism assault than it was a year ago when anthrax was sent
through the mail.
Always consult your physician
for more information.
What Is Smallpox?
Smallpox is a contagious,
sometimes fatal, infectious disease. There is no specific treatment
for smallpox, but protection from the disease is possible with vaccination.
What Are the Different
Forms of Smallpox?
There are two clinical
forms of smallpox:
Historically, variola
major has an overall fatality rate of about 30 percent; however,
flat and hemorrhagic smallpox usually are fatal.
According to the Centers
for Disease Control and Prevention (CDC), smallpox outbreaks
have occurred from time to time for thousands of years, but the
disease is now eradicated after a successful worldwide vaccination
program. The last case of smallpox in the United States was in 1949.
The last naturally occurring case in the world was in Somalia in
1977. After the disease was eliminated from the world, routine vaccination
against smallpox among the general public was stopped because it
was no longer necessary for prevention.
Always consult your physician
for more information.
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